Haapasaari K, Rossi O, Risteli J, Oikarinen A
Dept of Dermatology, University of Oulu, Finland.
Eur Respir J. 1998 Jan;11(1):139-43. doi: 10.1183/09031936.98.11010139.
There are only a few studies on the adverse effects of inhaled corticosteroids on the skin in asthmatic patients. Therefore, we evaluated the effect of inhaled corticosteroids on de novo collagen synthesis of skin and bone, skin thickness and the total amount of skin collagen. Twenty seven consecutive new asthmatic patients, on a moderate dose of budesonide or beclomethasone dipropionate, were invited to take part in this prospective study. Radioimmunological analyses of aminoterminal propeptides of type I and III procollagens (PINP, PIIINP, respectively) in suction blister fluid (SBF) of skin and in serum and carboxyterminal propeptide of type I procollagen (PICP) and cross-linked carbox terminal telopeptide of type I collagen (ICTP) in serum were performed at entry and after 3 and 6 months of inhaled corticosteroid treatment. Ultrasound measurements of skin thickness at two sites were performed at entry, at 3 and 6 months and after 1-2 yrs of inhaled corticosteroid treatment in 20 patients, six of whom had been prescribed one or more courses of oral corticosteroids. Skin hydroxyproline of punch biopsies was determined to measure the total amount of skin collagen (males, at entry and at 6 months). Skin thickness and the total amount of skin collagen on the abdomen were unchanged after 1-2 yrs of inhaled corticosteroid use. A slight decrease was observed in the upper arm skin thickness, especially in those subjects who had received inhaled plus oral corticosteroids. The procollagen propeptide concentrations (PINP, PIIINP) were markedly decreased in SBF at 3 months and remained at this level at 6 months. In serum, a slight decrease was seen in the PINP, PIIINP and ICTP concentrations at 3 and 6 months. In conclusion, inhaled corticosteroids decrease the collagen synthesis of skin and bone, but skin thickness and the total amount of collagen in skin are not changed markedly after 1-2 yrs of treatment.
关于吸入性糖皮质激素对哮喘患者皮肤不良反应的研究仅有少数几项。因此，我们评估了吸入性糖皮质激素对皮肤和骨骼新生胶原合成、皮肤厚度及皮肤胶原总量的影响。连续27例新诊断的哮喘患者，接受中等剂量布地奈德或丙酸倍氯米松治疗，受邀参加这项前瞻性研究。在研究开始时以及吸入糖皮质激素治疗3个月和6个月后，对皮肤抽吸水疱液（SBF）及血清中I型和III型前胶原氨基端前肽（分别为PINP、PIIINP）以及血清中I型前胶原羧基端前肽（PICP）和I型胶原交联羧基末端肽（ICTP）进行放射免疫分析。对20例患者在研究开始时、3个月和6个月以及吸入糖皮质激素治疗1 - 2年后进行两个部位的皮肤厚度超声测量，其中6例患者曾接受过一个或多个疗程的口服糖皮质激素治疗。测定打孔活检皮肤的羟脯氨酸含量以测量皮肤胶原总量（男性，在研究开始时和6个月时）。吸入糖皮质激素使用1 - 2年后，腹部皮肤厚度和皮肤胶原总量未发生变化。上臂皮肤厚度略有下降，尤其是那些接受过吸入加口服糖皮质激素治疗的患者。3个月时SBF中前胶原前肽浓度（PINP、PIIINP）显著降低，并在6个月时维持在该水平。血清中，3个月和6个月时PINP、PIIINP和ICTP浓度略有下降。总之，吸入性糖皮质激素可降低皮肤和骨骼的胶原合成，但治疗1 - 2年后皮肤厚度和皮肤胶原总量未发生明显变化。
